Required Service Application
We appreciate your interest in our organization and are sincerely interested in your background and qualifications. Please answer all questions as thoroughly as possible so we may review this information in consideration of volunteer services with our organization. We are an Equal Opportunity agency and will accept volunteers in designated positions without regard to race, color, religion, sex, national origin, age, disability, veteran status, military status, sexual orientation, genetic information nondiscrimination act or any other locally mandated classifications.
Contact Information
First name:
*
Last name:
*
Middle name:
*
Title:
Choose
Dr.
Miss
Mr.
Mrs
Ms.
Reverend
Street 1:
*
Street 2:
City:
*
State:
Choose
AL
AR
CA
CO
FL
GA
LA
NC
NJ
NY
OH
PA
SC
TX
VA
*
Zip:
*
Home phone:
*
OK to call me here
Email address:
*
Date of birth:
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
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Dec
Day
1
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2022
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1917
*
Criminal History
Have you ever been convicted of a felony or misdemeanor?
Felony or Misdemeanor:
Choose
No
Yes
*
Please list any felony or misdemeanor convictions
Requirements
What are the requirements for these volunteer hours? Who are these required for and when is the due date?
Requirement:
Choose
Church
College
Court/Lawyer
High School
Jobs Plus
*
I would like to serve up to:
hours:
Choose
Daily
Monthly
One time
Weekly
When are these hours due by?
Rescue Mission Services
Please indicate if you have received any of the following services from the Rescue Mission; housing, shelter, meals, and/or outreach services.
Have you used Rescue Mission services?:
Choose
No, I have never used services
Yes, I am currently using services
Yes, I have used services in the past
*
If yes please list services utilized
Returning Volunteer
Have you volunteer with the Rescue Mission in the past?
Yes or No:
Choose
No
Yes
*
If yes please list all areas you have volunteered
Skills/Interests
Please list or explain any skills or interests you are looking to use/expand while volunteer at the Rescue Mission.
Availability
Please indicate the days and times you are usually available to volunteer.
Sun
Mon
Tue
Wed
Thu
Fri
Sat
Morning:
Afternoon:
Evening:
Emergency Contact
In the event of an emergency whom should we notify?
First name:
*
Last name:
*
Title:
Choose
Dr.
Miss
Mr.
Mrs
Ms.
Reverend
Street 1:
Street 2:
Street 3:
City:
State:
Choose
AL
AR
CA
CO
FL
GA
LA
NC
NJ
NY
OH
PA
SC
TX
VA
Zip:
Home phone:
*
Work phone:
Relationship:
Choose
Aunt/Uncle
Co-worker
Friend
Grandparent
Neighbor
Parent
Sibling
Son/Daughter
Spouse/Significant Other
Supervisor
*
Employer
Please list your current or most recent employer, if applicable.
Employer name:
First name:
Last name:
Title:
Choose
Dr.
Miss
Mr.
Mrs
Ms.
Reverend
Street 1:
Street 2:
Street 3:
City:
State:
Choose
AL
AR
CA
CO
FL
GA
LA
NC
NJ
NY
OH
PA
SC
TX
VA
Zip:
Home phone:
Work phone:
I Agree
I certify that the statements and representations made in this volunteer application are true and correct and have been given voluntarily. I understand this information may be disclosed to any party with legal and proper interest, and I release this agency from any liability whatsoever for supplying such information. I understand that I will not be paid for my services as a volunteer. I agree to abide by the policies and proceedures of the Rescue Mission. I understand that the Rescue Mission will not reimburse me for mileage. As a nonpaid volunteer, I understand that I am not covered by the Rescue Mission's medical insurance. If I am injured while donating services to the Rescue Mission, the Rescue Mission is not responsible for any medical fees. I hereby release the Rescue Mission and its representatives from liability and all other persons, corporations or organizations for furnishing such information. As a Rescue Mission volunteer, I agree not to disclose any written or oral information about clients, employees, donors, volunteers, customers or other confidential information - i.e., organization finances. I understand that the Rescue Mission has a legal and ethical responsibility to maintain client, employee, donor, volunteer and customer privacy. I also agree that no photos or videos may be taken while on Rescue Mission property without prior permission of the Communications Director or the designated employee.
By submitting this form, I attest that the information I have provided on the form is true and accurate. I agree that I will obtain and read the Volunteer Handbook and Volunteer Policies. I understand that by submitting this application I will undergo a criminal and background screening process prior to becoming an active volunteer.
I Agree
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